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Umar Khan, MD SEACSM 2/5/2011. My arm keeps getting hurt 18 yo male football player with recurrent history of arm pain. Has been having symptoms off and.

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Presentation on theme: "Umar Khan, MD SEACSM 2/5/2011. My arm keeps getting hurt 18 yo male football player with recurrent history of arm pain. Has been having symptoms off and."— Presentation transcript:

1 Umar Khan, MD SEACSM 2/5/2011

2 My arm keeps getting hurt 18 yo male football player with recurrent history of arm pain. Has been having symptoms off and on since Symptoms were bilateral on occasion, but usually down one arm or the other. Three years ago, playing football while tackling, contact sent symptoms of pain, numbness and weakness down both arms. Patient doesnt remember if he returned to play symptom free, however that football season, every impact he had would reproduce symptoms (down both arms or either arm). Parents noted continued weakness in his upper extremities two months after that football season. He didnt play in 2008, and in 6/2009 while cutting the grass, patient lifted up his lawnmower and had numbness and tingling down his left arm.

3 In 2009, he played football without any symptoms, was evaluated for the first time in 2009 before playing. 9/2010, had another episode, affecting his right arm. He initially stated this was his 1 st episode of the year, however later on repeat f/u evaluation, he admitted that he would have symptoms a few times per week, but they werent bad enough to tell anybody about it.

4 Unremarkable PMHx, Sx, Fam Hx, Social Hx. No meds or allergies.

5 Gen: WN, WD NAD lbs Neck Exam: no ttp along c-spine or paravertebral muscles, he did have ttp on his right trapezius muscle. Neck had FROM and full strength in all directions without symptoms. Spurlings test was positive reproducing symptoms on his right and causing right trapezius pain. Neuro exam: CN II-XII intact, DTRs 1+ and symmetric in his upper and lower extremities, Motor strength was 5/5 and symmetric in all 4 extremities both proximal and distal. Negative Hoffmans and inverted BR reflex.

6 Recurrent Stingers Cervical Canal Stenosis Burning hand syndrome Malingering Acute Brachial Neuropathy Tumor Cervical Cord Neuropraxia

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10 Standard Cervical Spine X-Rays, shows no pathology except for loss of lordosis. MRI on 8/10/09: No disk bulging or protrusion present, normal vertebral body heights. No edema in the bones or spinal cord. No evidence of foraminal narrowing or spinal cord stenosis. MRI on 10/16/10: Normal cervical spine, C3-C4 level small bulging disc on the right, also some minimal disc bulging at C4-C5. No evidence of spinal stenosis. Loss of lordosis in the cervical spine. SAC 5.5mm

11 Sagital-diameter spinal-cord, spinal-canal, and vertebral-body diameter measurments. x = sagittal spinal-cord diameter, y = sagittal spinal-canal diameter, z = sagittal vertebral- body diameter.

12 Recurrent brachial plexopathy Spear tacklers spine.

13 Relative Rest, Avoid Contact sports for now NSAIDS if currently symptomatic Rehab/PT

14 F/U in 3 months. With repeat films to see if there is return of lordosis of the cervical spine.

15 Once he has lordosis of his cervical spine and is asymptomatic, and has a normal strength and full range of motion. Will give him a trial of activity.

16 No Contraindications to Return to Play ** Single-level Klippel-Feil deformity/congenital fusion below C2 Spina bifida occulta Resolved stinger or brachial plexus neurapraxia (2 or less) Healed herniated disc Healed subaxial cervical spine fracture (C3-C7) Healed facet fracture Healed lamina fracture Healed spinous process fracture (clay shoveler's fracture) Healed one-level anterior cervical fusion Healed single or multiple level posterior cervical foraminotomy

17 Relative Contraindications to Return to Play ** Resolved transient quadriplegia (1 episode) Resolved stinger or brachial plexus neurapraxia (3 or more) Non-healed/non-resolved asymptomatic herniated disc or severe foraminal stenosis Healed C1 fracture Healed C2 or Odontoid fracture Any healed subaxial spine fracture with minimal or mild residual displacement, deformity, or decreased range-of- motion Healed two-level anterior cervical fusion Healed one-level posterior cervical fusion

18 Absolute Contraindications to Return to Play or Participation ** Clinical or radiographic evidence of rheumatoid arthritis, anklosing spondylitis, or diffuse idiopathic skeletal hyperostosis Arnold-Chiari malformation Os odontoidium or congential odontoid agenesis/hypoplasia Klippel-Feil deformity/congenital fusion or anomaly involving C1 and/or C2 Multiple-level Klippel-Feil deformity/congenital fusion below C2 C1-C2 hypermobility or instability (ADI > 4 mm) Spear tacklers spine deformity Transient quadriplegia (2 or more episodes) Non-healed/non-resolved symptomatic herniated disc or severe foraminal stenosis Cervical myelopathy MRI evidence of spinal cord contusion, edema, or abnormality Any healed cervical spine fracture/dislocation (lateral mass fracture with subluxation/dislocation) Any healed cervical spine fracture or injury with residual instability > 3.5 mm/11° Any healed subaxial spine fracture with residual displacement, deformity, or decreased range-of-motion C1-C2 fusion Three-level (or more) anterior cervical fusion Two-level (or more) posterior cervical fusion Cervical laminectomy or laminaplasty


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